'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Rawlins slams 'hurry' over Q&O

Quality and outcomes indicators were 'constructed in a hurry' and could be pulled into line with NICE guidance within two years, according to NICE chair Professor Sir Michael Rawlins, writes Cato Pedder.

In an exclusive interview, Sir Michael told Pulse: 'As I understand it, the Q&O framework was constructed in a hurry. But it is not locked in place and there is talk about it being joined to NICE.'

The GPC's review of Q&O is due by 2006 and with NICE's output of guidelines set to double in the next year, Sir Michael was confident that NICE could take over the framework. 'NICE guidance will be more than enough to cover it,' he said.

The GPC reacted angrily, insisting that 18 months' work had gone into Q&O and that it was determined it would remain independent.

Dr Hamish Meldrum, GPC joint deputy chair, said the criticism was 'not valid at all'. 'There is no chance that NICE could be in charge of Q&O.'

Sir Michael refuted criticism of NICE over disparities between its guidelines and the quality framework. Asked if GPs should follow NICE guidance on COPD which rules out spirometry/reversibility testing or the Q&O framework which offers payment for carrying out such tests, Sir Michael said: 'The answer is obvious – if they're getting paid for it'. He added: 'Revision of that should be considered in future years.'